Individual
STACI DIANE HENDRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
4930 OVERLAND DR, LAWRENCE, KS 66049-4132
(785) 760-4501
(785) 727-1805
Mailing address
734 N 1851ST DIAG RD, LECOMPTON, KS 66050-4114
(785) 760-4501
(785) 727-1805
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
000947
KS
Other
Enumeration date
12/15/2009
Last updated
05/08/2015
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